M059 – External frontal-ethmoidal sinusectomy and/or reconstruction - unilateral
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
External frontal-ethmoidal sinusectomy and/or reconstruction, unilateral. Surgical Service (Suffix A) The surgical fee includes pre-operative care (visits 1-2 days prior to surgery) and post-operative care for up to two weeks, with the exception of the first and second post-operative visits and the day of discharge visit which may be claimed separately. The listed benefit is for a unilateral procedure. For detailed rules on included pre- and post-operative care, see the Surgical Preamble (, ). Assistant Service (Suffix B) Payable when an assistant is required. The fee is calculated by adding 6 basic units to the time units for the duration of the assistance. See - for calculation details. Anaesthesia Service (Suffix C) Payable when an anaesthetist is required. The fee is calculated by adding 10 basic units to the time units for the duration of anaesthesia. See - for calculation details.
When to Use
- Use M059 for an external approach to the frontal and/or ethmoid sinuses, such as a Lynch-type procedure or external ethmoidectomy, when an endoscopic approach (e.g., Z334) is not performed.
- Use this code for open surgical reconstruction of the frontal-ethmoidal complex following trauma or for the management of complex sinonasal pathology requiring an external incision.
Common Pitfalls
- Billing M059 in conjunction with endoscopic sinus surgery codes (e.g., Z334) for the same side without applying the 85% multiple procedure reduction rule as per the Surgical Preamble.
- Failing to recognize that the fee includes post-operative care for two weeks, leading to inappropriate billing of routine follow-up visits within that window.
Billing Tips
- Ensure the first and second post-operative visits and the day of discharge visit are billed separately using the appropriate consultation or assessment codes, as these are explicitly excluded from the M059 global fee.
- If performing bilateral procedures, bill the second side at 85% of the M059 fee, ensuring the claim reflects the unilateral nature of the primary code.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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